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Use a video game with a random map generator, then fill in a city around a river? (Age of Empires type games would work well for this)
Play a city building game for an hour and screen-cap the result? (Modifying for era, of course).
I'd probably open up the <insert medieval-style RTS game here> scenario editor, click the "random terrain" button until I had something with a river, then start placing the generic house building those games inevitably have until I had a decent map going.